![]() ( Reference Rietjens, van Delden and Onwuteaka-Philipsen2008), sedation was induced by benzodiazepines, often combined with morphine. In 83% of cases from a study in the Netherlands by Rietjens et al. but was not reported by specialists in palliative care. Seale ( Reference Seale2009) found that prescription of opioids alone for palliative sedation occurred in a fifth of the cases in the U.K. Reporting on the types of medication used and the frequency of the use of palliative sedation for patients at the end of life also varies considerably across the globe. There are also many inconsistencies with regard to the prevalence and effect of sedation, food and fluid intake, and the possible life-shortening effect of palliative sedation (Claessens et al., Reference Claessens, Menten and Schotsmans2008). These are influenced by the country, context, and clinical setting or site at which a study was conducted (de Graeff & Dean, Reference de Graeff and Dean2007 Beel et al., Reference Beel, McClement and Harlos2002). Large differences in defining palliative sedation are reported in the literature, as is reporting on the frequency of symptoms and sedation practices between countries and services. The most common approach taken to ameliorate terminal restlessness is the provision of “terminal or palliative sedation.” The European Association for Palliative Care considers the use of sedation to be an important and often necessary symptom management measure in the care of palliative care patients who are experiencing uncontrollable symptoms that cause terminal restlessness (Hauser & Walsh, Reference Hauser and Walsh2009 Cherny & Radbruch, Reference Cherny and Radbruch2009 de Graeff & Dean, Reference de Graeff and Dean2007). ![]() Patients may also experience such psychological and spiritual/existential symptoms as severe anxiety, anguish, and fear (Boston et al., Reference Boston, Bruce and Schreibe2011 Lavoie et al., Reference Lavoie, Blondeau and De Koninck2008). Terminal restlessness can develop days or even weeks before death and manifests in such persistent distressing physical symptoms as pain, breathlessness, and agitated delirium (de Graeff & Dean, Reference de Graeff and Dean2007 Morita et al., Reference Morita, Chinone and Ikenaga2005 Fainsinger et al., Reference Fainsinger, DeMoissac and Oneschuk2000). For the purposes of the present paper, the term “terminal restlessness” will be employed to describe this symptom. Expressions such as “terminal restlessness,” “terminal delirium,” and “terminal agitation” are used interchangeably throughout the literature. Refractory symptoms, defined as symptoms that cannot be adequately controlled despite aggressive efforts to identify a tolerable therapy that does not compromise consciousness (Cherny & Portenoy, Reference Cherny and Portenoy1994), are common in patients with advanced cancer or other advanced diseases.
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